Monday, July 27, 2015

Alexithymia is
characterized by difficulties in identifying, describing, and processing one's
own feelings, often marked by a lack of understanding of the feelings of
others, and difficulty distinguishing between feelings and the bodily
sensations of emotional arousal. Alexithymia is not a formal clinical diagnosis
and is best conceptualized as a dimensional personality trait that is normally
distributed in the general population (with estimates of 10%) and varies in
severity from person to person. However, there is evidence to suggest that it
is associated with an increased risk for mental health problems. For example,
several studies indicate that even in childhood, alexithymia and difficulties
in the domain of emotion processing are positively related to internalizing
problems such as anxiety and depression.

Research indicates that
alexithymia overlaps with autism spectrum disorder (ASD). Although alexithymia
is not a core feature of autism, recent studies have found varying degrees of
this trait in 50 to 85% of individuals with autism ASD. The alexithymia trait
appears to have the following properties: (a) it is more common in individuals
with ASD than in the general population (b) it is more common in parents of
individuals with ASD than in parents of individuals with another developmental
disabilities, (c) it is stable over time in ASD, and (d) problems in the domain
of emotion awareness are positively related to depression, anxiety, somatic
complaints, worry and rumination. There is also evidence to indicate that the
alexithymia trait might be part of the broader autism phenotype and a
significant component of the emotion processing difficulties observed in ASD. It
is uncertain whether the problem of emotion recognition
commonly attributed to individuals on the autism spectrum is a result of the
disorder itself, or if it is due to the large co-occurrence (comorbidity)
between alexithymia and autism.

Given the apparent
association between alexithymia and autism, it’s especially important to
investigate the relative contribution of this dimensional trait to the
impairment in social functioning experienced by individuals with ASD. An
important question for future research relates to the prevalence of high levels
of alexithymia in ASD compared to neurotypical individuals and how to explain
the high co-occurrence (comorbidity) between alexithymia and ASD. Is
alexithymia a neuroanatomical structural consequence or is the result of a
neurobiological impairment, or is it a distinctive personality trait of
individuals with ASD? Does the level of alexithymia predict symptom severity in
ASD? Although not a diagnostic feature of autism, would alexithymia be a useful
diagnostic marker for ASD? Because alexithymia is associated with increased
risk of mental health problems (i.e., anxiety and depression), should a measure
of alexithymia be included in an assessment battery for ASD? As with most
autism research, there are more questions than answers.

Friday, July 10, 2015

It is estimated that
nearly a half million youth with autism will enter adulthood over the next
decade. As children with autism become adults their primary medical care will
move from pediatrics to adult medicine. A survey by the Autism Research Program
at Kaiser Permanente Northern California found that many healthcare providers
are ill prepared to treat adults on the autism spectrum. The findings were
reported at the International Meeting for Autism Research in Salt Lake City, Utah.

Researchers polled
providers of adult primary care, mental health, and obstetrics and gynecology
services through the insurer’s network. Practitioners were asked about their
ability to recognize autism, their knowledge of the disorder, their comfort
level in treating those with the condition and their need for training and
resources.

Of 922 providers surveyed,
77 percent rated their ability to treat patients on the spectrum as poor or
fair. While more that 90 percent of the providers said they would investigate
the possibility of autism in patients with limited eye contact, most
under-reported the number of people on the autism spectrum who were actually
under their care. In addition, only 13 percent of providers indicated that they
had adequate tools or referral resources to appropriately accommodate those
with autism.

To better understand the
providers’ responses, follow-up interviews were conducted with nine primary
care physicians. The researchers found that the majority had received limited
or no autism training in medical school or during their residencies. All of the
providers indicated a need for more education and improvements in the
transition from pediatric care providers to adult medicine for those on the
autism spectrum.

The preparation of
healthcare providers is a pressing issue as an increasing number of individuals
with autism are expected to enter adulthood in the coming years. Further
research is urgently needed to study the transition from pediatric to adult
healthcare and identify strategies that will lead to better medical care for
adults on the autism spectrum.

Thursday, July 9, 2015

Atypical or unusual sensory
responses are common in children with autism spectrum disorder (ASD) and often
one of the earliest indicators of autism in childhood. A large percentage of children with ASD (78 to 90%) have sensory
processing problems. Sensory issues are now
included in the DSM-5 symptom criteria for restricted, repetitive patterns of
behavior, interests, or activities (RRBs). These are mostly problems of sensory modulation expressed
as hyper-or hypo-reactivity to sensory input or unusual interest in sensory
aspects of the environment. When present, sensory problems may interfere
with performance in many developmental and functional domains across home and
school contexts, including daily living activities such as eating. Research
suggests that extreme reactions or rituals involving taste, smell, texture, or
appearance of food or excessive food restrictions are fairly common and may be
a presenting feature of ASD. This includes “selective” or “picky eating,” which
is defined as eating a limited variety of food and refusal to eat or taste new
foods.

Research

A study published in the
open access journal, Autism
Research and Treatment, examined the relationship between sensory
processing and eating problems in children with ASD. A total of 95 Children
with a diagnosis of autism, pervasive developmental disorder not otherwise
specified (PDD-NOS), or Asperger syndrome, aged 3–10 years, were included in
the study. They had at least one other associated condition; the most common being
attention deficit disorder (23%), hyperactivity (22%), and intellectual
disability (23%). Parents completed two questionnaires: (a) the Eating Profile,
which was developed by clinicians and focuses on developmental eating
milestones, mealtime behaviors of the child, such as eating autonomy and impact
on the daily life of the family and (b) the Short Sensory Profile (SSP), a
standardized questionnaire consisting of 38 items that help clinicians and
researchers to quickly identify children with sensory processing issues (e.g..,
typical response, probable difference, or definite difference).

Results

The results indicated that
65 percent of children in the study showed a definite difference and 21 percent
a probable difference in sensory processing on the total score of the Short
Sensory Profile. Overall, children with “definite” sensory problems had
significantly more eating problems than those with “typical” performance.
Children with tactile sensitivity, taste/smell sensitivities, as well as
visual/auditory sensitivities had significantly more eating problems than
children with typical performance. For the total score of the SSP and for three
sections (taste/smell sensitivity; auditory filtering; visual/auditory
sensitivity), having a definite problem was significantly associated with a
greater number of eating problems as measured by the Eating Profile. Although
not statistically significant, there was a tendency for tactile sensitivity to
be associated with the number of eating problems. These results could not be
explained by age, sex, intellectual disability, attention deficit disorder, or
hyperactivity.

Discussion

The results of the study suggest
that certain sensory modalities may influence the number of eating problems
more than others. For example, children who were classified in the “definite
difference” category on “tactile sensitivity” showed problems with the social
behaviors at mealtime, as well as having unusual food preferences with respect
to commercial brands, specific recipes, color, texture, or temperature of the
food. These findings support an association of tactile defensiveness and food
selectivity in children with ASD. Exploration through touching is a preliminary
step to the introduction of new foods in young children. Children showing
sensory defensiveness might be less inclined to explore foods with their hands.
Others may have difficulties with the feel of utensils, the close presence of
other children, or the routine clean-up after a meal.

Children with taste and/or
smell sensitivity issues had mealtime problems. Similar to tactile sensitivity,
they demonstrated problematic mealtime behaviors, but even more pronounced food
preferences. This affected the eating autonomy more than tactile sensitivity, primarily
in eating without assistance and using eating utensils, such as a fork.
Auditory filtering affected these behaviors to the same extent as taste/smell
sensitivities. This confirms the notion that eating is a complex multisensory
experience.

A significant association
was also found between visual/auditory sensitivity and the number of eating
problems. Mealtimes can indeed be noisy during the preparation of food, including
the manipulation of utensils and ongoing conversations. Even the sound of their
own chewing can upset some highly sensitive children. Whether at school, or in
child care, the noise level is usually above the one experienced in a child’s
home. Likewise, children with visual sensitivities may react more to the visual
stimuli of foods which may evoke unpleasant memories of their taste or texture.
In typically developing children the visual exploration of food may actually facilitate
the expectation of their taste/texture and thereby ease the acceptance of new
foods.

Implications

Because sensory hyper- and
hyporesponsiveness may be observable in infancy, these findings have
implications for early detection and intervention and suggest that children
with ASD may benefit from timely interventions focusing on the sensory
components of eating. Although it remains to be determined how these issues
might be specifically addressed in therapy, the frequency and severity of
eating problems perceived by parents highlight the need for systematic
evaluation of this daily living activity in combination with the sensory
processing issues associated with food preferences and their effect on adaptive
functioning (e.g., daily living skills). Consequently, an examination of
mealtime behaviors might be included as part of the diagnostic assessment,
including a sensory profile, in order to provide guidance to caregivers and
parents.

Although therapeutic
interventions to enhance sensory processing functions are popular in the
treatment of ASD, the efficacy of these treatments is mixed and continues to be
debated among researchers. Nevertheless, best practice guidelines indicate that
when indicated, treatment programs for children with ASD should integrate an
appropriately structured physical and sensory milieu in order to accommodate
any unique sensory processing challenges. Of course, all interventions and
treatments should be based on sound theoretical constructs, robust
methodologies, and empirical studies of effectiveness. Different approaches to
intervention have been found to be effective for children with autism, and no
comparative research has been conducted that demonstrates one approach is
superior to another. The selection of specific interventions should be based on
goals developed from a comprehensive assessment of each child’s unique needs
and family preferences. A more detailed discussion of assessment domains (e.g.
communication, social, RRBs, sensory, academic) can be found in A Best Practice Guide to Assessment and Intervention for Autism
Spectrum Disorder in Schools (2nd Edition).

Wednesday, July 1, 2015

Children
with autism spectrum disorders (ASD) often have strong preferences for
screen-based media, particularly video games. Although a large body of
research has demonstrated a clear effect of both video game content and genre
on behavior problems among typically developing children and adolescents, the relationship between these variables has not
been previously examined among children with ASD. This study
examined the relationships between aspects of video game use and problem
behaviors among a sample of 169 boys (ages 8–18) with ASD. Parents reported on
their children's behavioral functioning and video game habits and preferences,
including the average number of hours spent playing video games per day,
preferred game types (genres), and problematic (e.g., addictive) video game
play patterns.

Results

The results indicated that amount of game play alone (an average of 2.4
hours a day) was not associated with problem behaviors. Rather, the most
reliable predictors of problem behaviors, even
when controlling for age and amount of time spent playing video games, were video game
genre and problematic, or addictive, qualities of play. Specifically,
significant positive relationships were found between problematic video games
use and both inattention and oppositional symptoms. Boys who played Role-Playing (genre) games had
higher levels of both problematic game use and oppositional behavior. Interestingly,
however, hyperactivity was not significantly associated with either problematic
video game use or video game genre. Lastly, educational and sports games
predicted less oppositional behavior.

The results of this study are consistent, in part, with findings from
the general population. For example, the significant association between
problematic video game play, inattention, and oppositional behavior reported in
the study is similar to those reported in adolescents and adults without ASD. The
finding that Role-Playing games were highly associated with problematic video
game play and externalizing problem behavior is also consistent with previous
research among individuals without ASD

Implications

This study underlines the clinical importance of examining video game use patterns among children
with ASD, and points to a need for future experimental and longitudinal research
in this area. For example, Role-Playing games may contribute to an even greater
potential for problematic game use patterns among children with ASD, given
their particular game-design features. Since children with ASD tend to engage
in restricted and repetitive behaviors (RRBs), they might be at higher risk for
developing addictive game play patterns. Preoccupation with video games and
trouble disengaging from them may serve as antecedents for disruptive behavior,
as has been anecdotally reported among other children. It appears that for
children with ASD, the potential for preoccupation represents a key game play
quality that relates closely with the occurrence of problem behaviors. Future research
in this area is critical in order to inform video game use recommendations for
both parents and clinicians. As emerging research investigates the
effectiveness of video-game based interventions for improving functional
outcomes, it will be equally important to understand the mechanisms and nature
of problematic aspects of game play among children with ASD.

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